Objective Carotid sinus hypersensitivity (CSH) is common in older people. The authors hypothesise that patients with CSH have a higher mortality than a geographically, age-matched older cohort. Design A retrospective cohort study compared to geographical and age-matched data from the Office of National Statistics. Setting Specialist clinic in tertiary centre. Patients 1504 patients with CSH were identified from a single syncope outpatient assessment service between 1990 and 2001. Interventions Vital status was confirmed, and death certificates were sought for all deceased patients up to 2003. Main outcome measures Kaplan-Meier survival curves were analysed within the cohort according to three different subtypes of CSH. Standardised mortality rates (SMRs) were determined using geographical and age-matched data from the Office of National Statistics. Results There was no difference between CSH patients and the general population in SMRs for all causes, or for cerebrovascular or cardiovascular deaths. There was no difference in survival between the three subtypes of CSH (p=0.2) within the study cohort. Conclusion CSH is not associated with a higher mortality than the general population, and there are no differences in mortality between the three subtypes of CSH. This confirms earlier findings and reinforces the neutral effect of CSH on mortality.